English Peer-reviewed Publications Research Articles

Rapid molecular testing for antimicrobial stewardship and solid organ transplantation.

Several molecular platforms now exist for early detection of infectious pathogens. In this review, we present the currently available literature summarizing clinical outcomes using rapid diagnostic tests (RDTs) in the solid organ transplant (SOT) population. We also present potential benefits and drawbacks of these technologies for SOT patients. We completed a PubMed search querying for 31 specific RDTs AND ("SOT"). We also queried PubMed for studies on RDT outcomes in the general population. References of the resulting relevant studies were reviewed and incorporated if the study population included at least one SOT patient. All culture specimen types were included. Only full-text peer-reviewed publications in English were examined. Our search yielded eleven studies. Across these studies, integrating RDTs with ASP intervention led to faster species identification and susceptibility results, faster time-to-optimal therapy, decreased hospital length-of-stay and costs, and decreased mortality. Potential drawbacks of RDTs in the SOT population included: overdiagnosis due to increased sensitivity (i.e., Clostridium difficile), decreased yield of tests for respiratory pathogens, and lack of identification of important pathogens in this population such as, Aspergillus species. Although there is a scarcity of studies involving SOT patients, current available data suggests that the use of RDTs helps improve patient outcomes and minimizes inappropriate antimicrobial use when coupled with proactive ASPs. Future studies should focus on clinical outcomes in SOT patients specifically, as well as how to optimize the use of RDTs in conjunction with traditional microbiology methods.

Effect of Visiting Restrictions in the NICU during the Pandemic: A Literature Review

Background: Parents of infants in the neonatal intensive care unit (NICU) experienced a tremendous amount of stress with the changing policies which added to the trauma of having an infant in the NICU. While family-centered and developmental care are the norms in the NICU, the ‘visiting’ policy that involved complete lockdown, one parent at a time, restrictions on partners and extended families including grandparents, no kangaroo care, no breastfeeding, … etc. affected women emotionally, impacting breast milk production, breastfeeding and increased incidence of postpartum depression. Purpose: The purpose of this literature review is to explore the consequences of visiting restrictions in NICUs during the pandemic. Methods: Search terms, such as NICU, neonatal intensive care unit, parents, COVID-19 and visit, were used to search databases, such as CINAHL, PubMed and EBSCOhost, to identify peer-reviewed publications in English. The publications were after March 2020 by nature of the topic. Results: Visiting restrictions have a ripple effect on the infant and the family, where breastfeeding, milk production and parental mental health were affected. The changing policies have affected nurses too. Conclusion: Families are affected by the rapidly changing visiting policies during the COVID-19 pandemic. This has a ripple effect on mental health, bonding, breast milk production and family dynamics. Implications for Nursing: Babies born during these challenging times must be followed-up for their developmental milestones and social and educational achievement. Keywords: Neonatal intensive care unit: NICU, Parents, Visit, Pandemic, COVID-19.

Upadacitinib for the Treatment of Rheumatoid Arthritis: An Extensive Review.

To review the characteristics, efficacy, safety, pharmacoeconomics, and place in therapy of upadacitinib, a Janus kinase (JAK) inhibitor, in the treatment of rheumatoid arthritis (RA). PubMed (January 2003-May 2022) was searched using upadacitinib and ABT-494. Human studies published in peer-reviewed publications in English were the primary sources for efficacy and safety data. In randomized, double-blind, controlled clinical studies, upadacitinib demonstrated statistically significant improvement in RA symptoms as monotherapy and in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) when compared with csDMARD monotherapy or to adalimumab or abatacept in combination with csDMARD therapy in patients with RA. American College of Rheumatology 20% response rates were 68% to 79% for upadacitinib monotherapy and 64% to 84% for upadacitinib plus csDMARD therapy, compared with 28% to 59% for csDMARD-only therapy and 63% to 74% for biologic DMARD (bDMARD) plus csDMARD therapy. Long-term extension studies demonstrated similar findings. Upadacitinib had similar rates of serious infections, herpes zoster, major cardiovascular events, and venous thromboembolic events as other JAK inhibitors. Upadacitinib was similar in cost to tofacitinib and twice as high as baricitinib based on current estimated costs to patients, but actual costs may vary. Upadacitinib is an alternative therapy to other JAK inhibitors and bDMARDs in patients with moderate to severe RA who have had an inadequate response to a tumor necrosis factor inhibitor alone or in combination with a csDMARD. Upadacitinib is an effective JAK inhibitor for use in RA.

Urban Interventions and Participation Tools in Urban Design Processes: A Systematic Review and Thematic Analysis (1995 – 2021)

All cities need to change and transform to become more livable. Urban interventions are effective for observing the changes and participation tools are in use for collecting data from urban contexts. Nevertheless, the two research fields remain thematically disintegrated within themselves and between each other in the literature that spread across disciplines. This article aims to contribute to and advance the academic conceptualization of urban interventions and participation tools within urban design processes. In order to establish a solid basis and provide conceptual clarity, the research domains of two study fields are explored from 1995 through 2021. We conducted a thematic analysis covering 176 peer-reviewed publications in English. The studies on urban interventions are synthesized and categorized into five main thematic areas: urbanism, community, sustainability, building types, and participation; while the studies on participation tools are investigated within four thematic areas: participation, digital tools, representations, and responsive cities. We conclude that the two research fields are highly interrelated and need to be studied together. This systematic review would trigger new perspectives and directions in the future, and provide a well-conceptualized base that combines urban interventions and digital participatory designs for both theory-based and practical studies.

Pulmonary Post-Acute Sequelae of COVID-19

Introduction: Persistent symptoms have been observed in a substantial proportion of survivors of COVID-19 since relatively early in the pandemic. Among these post-acute sequelae of COVID-19 (PASC), respiratory symptoms appear to be the most prevalent. Methods: We conducted a literature review of peer-reviewed publications in English on the clinical and epidemiological features of respiratory PASC in cohorts of 100 or more patients with a follow-up of four weeks or more after acute infection. Included studies reported the prevalence of persistent respiratory symptoms and/or the results of follow-up pulmonary function tests. Results: On our review included 14 studies across eight countries with a total of 2,380 patients. Subacute PASC was reported in 876 patients, and chronic PASC in 1,504 patients. The median age ranged from 44 to 67 years. The most common symptoms observed were fatigue (44%), dyspnea (40%), and cough (22%). Lung disease as a comorbidity was found in 13% of patients on average. Predominance of males was seen in all studies of subacute PASC and six out of eight studies of chronic PASC. The rates of comorbidities for subacute vs. chronic PASC were: hypertension 32% vs. 31%, cardiovascular disease 10% vs. 7%, diabetes mellitus 15% vs. 12%, kidney disease 7% vs. 4%, and lung disease 19% vs. 10%. Conclusion: Respiratory PASC seems to be more predominant as a chronic presentation, more common in male adults, and less common in older persons. Respiratory PASC is most often associated with fatigue, dyspnea, and cough. There was no strong correlation of severity of illness, acute respiratory distress syndrome, or intensive care unit admission with respiratory PASC.

Anxiety and Depressive Disorders in Children Born Preterm: A Meta-Analysis.

Preterm birth is associated with a high prevalence of psychiatric disorders including internalizing problems. However, there is a lack of consensus on the risk for depression and on specific diagnostic profiles. This meta-analysis investigates the independent pooled odds of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition anxiety and depressive disorders in children between 3 and 19 years of age born preterm compared with their term-born peers. PubMed/MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature electronic databases were searched (last updated in September 2019) using population ("child"), exposure ("preterm birth"), and outcome ("anxiety") terms for English peer-reviewed publications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed with the risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was estimated using fixed-effects models. Eleven independent studies met the inclusion criteria. The pooled sample comprised 1294 preterm and 1274 term-born children with anxiety outcomes and 777 preterm and 784 term-born children with depressive outcomes between 3 and 19 years of age. Children born preterm had significantly greater odds for anxiety (OR: 2.17; 95% CI, 1.43-3.29), generalized anxiety (OR: 2.20; 95% CI, 1.26-3.84), and specific phobia (OR: 1.93; 95% CI, 1.05-3.52) relative to their term-born peers. There were no significant between-group differences for reported depressive disorders. Preterm birth is associated with a higher prevalence of anxiety, but not depressive disorders, from 3 to 19 years of age, suggesting distinct etiological pathways in this high-risk population. The findings support variation in the rates of specific anxiety diagnoses, indicating the need to extend neurodevelopmental surveillance to encompass a holistic emotional screening approach.

The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review.

The objective is to determine the global population prevalence of rheumatoid arthritis (RA) based on population-based studies and assess factors that influence RA prevalence estimates. Four electronic databases were searched (ProQuest Central, MEDLINE, Web of Science, and EMBASE) for peer-reviewed English publications that report prevalence estimates of RA from 1980 and 2019. We included case-control studies, cross-sectional studies, and prospective or retrospective cohort studies in our search strategy. A random-effect meta-analysis model was used to produce the pooled prevalence estimates. The potential between-study heterogeneity was identified using sensitivity analysis, sub-group and meta-regression analyses. A total of 67 studies were included in the meta-analysis, containing 742,246 RA patients and 211,592,925 healthy controls in the study period. The global RA prevalence estimate was 0.46% (95% confidence interval [CI] 0.39-0.54; I2 = 99.9%) with a 95% prediction interval (0.06-1.27). The RA point-prevalence was 0.45% (95% CI 0.38-0.53%) between 1986 and 2014, while the pooled period-prevalence was 0.46% (95% CI 0.36% and 0.57%) from 1955 to 2015. The highest RA pooled prevalence (0.69%; 95% CI 0.47-0.95) was derived from linked data source studies. Based on meta-regression, the factors that explain the studies' heterogeneity of RA prevalence, including geographical location, the risk bias assessment of studies and sample size. The global prevalence of RA between 1980 and 2019 was 460 per 100,000 population, with variations due to geographical location and study methodology. Linked data are the preferred method to estimate RA population prevalence as they provide the best case ascertainment.

Knowledge, attitude, and clinical practice of dentists toward obstructive sleep apnea: A literature review

ABSTRACT Objective To review the knowledge, attitude, and clinical practice of dentists and dental specialists toward obstructive sleep apnea (OSA). Methods A literature search was performed on PubMed and ScienceDirect databases. Peer-reviewed English publications were reviewed. No time limit was applied. Results Four articles were included for the review. Years in the profession, specialist training, and gender were associated with the level of knowledge about OSA. Weight control was the most recognizable treatment for patients with OSA. Dentists agreed that OSA is a life-threatening disease, and they could be involved in detecting and treating OSA. Most dentists had no clinical experience of managing patients with OSA. Conclusion Dentists had a certain level of knowledge about OSA and were willing to deal with OSA. However, they lacked clinical experience. They were also enthusiastic about further education on OSA.

Review of empirical research on leadership and organizational learning

PurposeThis paper aims to investigate how the relationships between different leadership approaches and organizational learning have been examined in the literature, from which future research areas can be recommended.Design/methodology/approachThis systematic literature review applies matrix method to examine major literature in leadership and organizational learning. A total of 57 peer-reviewed English publications from 45 journals were selected and analyzed.FindingsThe synthesis of these empirical studies revealed as follows: the relationship between leadership and organizational learning has been mostly quantitatively investigated in many countries and sectors; multiple leadership styles have been identified to ameliorate processes, levels and capabilities of organizational learning and transformational leadership still remains the most commonly used style; there are mediating mechanism and boundary conditions in the relationship between leadership and organizational learning.Research limitations/implicationsThe literature search in this study was mainly focused on English articles only; therefore, some papers in other languages may have not been included.Practical implicationsThis review offers an overall picture of the existing knowledge of organizational learning and leadership that will be fruitful for practitioners to understand and replicate these concepts.Originality/valueThere are little systematic literature reviews on the relationship between leadership and organizational learning. This paper is among the first systematic reviews to analyze how leadership has been associated with organizational learning and provide potential research directions.

679 Psychological Outcomes of Parents of Children With Congenital Heart Disease: A Systematic Review and Meta-Analysis

Parents of children with congenital heart disease (CHD) are at risk of poor psychological functioning. The aim of this systematic review and meta-analysis was to examine psychological outcomes, defined as stress, anxiety, depression and psychological trauma, among parents of children with CHD aged 0 to 18 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Two reviewers independently screened five electronic databases and relevant reference lists. Peer-reviewed publications in English from 1980 to 2019 were included if the study sample comprised of parents of children with CHD aged 0 to 18 years and a comparison group of parents of children without CHD, and reported psychological outcomes on a standardised measure using cohort, cross-sectional, or randomised controlled trial designs. Pooled estimates were calculated using random-effects modelling. The systematic search yielded 703 publications, of which 33 studies met inclusion criteria and 9 studies were eligible for meta-analysis. Pooled estimates demonstrated parents of children with CHD scoring significantly higher for stress, SMD [95% CI]: 0.36 [0.08, 0.63], relative to parents of children without CHD. No significant between-group differences were evident for anxiety, 2.30 [-1.33, 5.93] and depression, 1.62 [-1.42, 4.67]. There was insufficient data to meta-analyse psychological trauma. To our knowledge, this is the first comprehensive meta-analysis concerning psychological outcomes of parents of children with CHD. Findings have implications for informing the development of targeted psychosocial interventions and care services for families, potentially buffering the risk of neurodevelopmental adversities in their children with CHD.

Combined Interventions to Reduce Burnout Complaints and Promote Return to Work: A Systematic Review of Effectiveness and Mediators of Change.

Burnout has adverse effects on the health and work-related outcomes of employees. Nevertheless, little is known about effective ways of reducing burnout complaints and facilitating full return to work, which defines rehabilitation. This study consists of a systematic review of the effects of combined interventions (i.e., both person-directed and organization-directed). It also includes the identification and description of mediators of change, thereby explaining how combined interventions do or do not work. Seven electronic databases were searched for English peer-reviewed publications: the Psychology and Behavioral Sciences Collection; PsycARTICLES; Web of Science; Scopus; SocINDEX; PubMed; and PsycINFO, using various combinations of search terms (e.g., burnout AND intervention). Out of 4110 abstracts published before 29 September, 2019, 10 studies (reporting the effects of nine combined interventions) fulfilled the inclusion criteria, which were defined using PICOS criteria (participants, interventions, comparators, outcomes and study design). Although the risk of bias of the included studies is high, all combined interventions were effective in facilitating rehabilitation. Results suggest that involving employees in decision-making and enhance their job control and social support, while eliminating stressors, explain the effectiveness of the intentions. With caution, workplace health promotion practitioners are encouraged to use these findings to tackle burnout among employees.

Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review

Autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) can compromise health and may be more prevalent amongst individuals with gender dysphoria (GD). Symptoms such as attention or social difficulties can impact assessment of GD, understanding of health information, and engagement in clinical care. To ensure neurodevelopmental conditions are adequately considered in gender health services, we aimed to systematically review the literature examining the prevalence of ASD and ADHD amongst individuals with GD. In this systematic review based on the PRISMA guidelines. MEDLINE and PsycINFO databases were searched for studies examining the prevalence of ASD and/or ADHD in individuals with GD or investigated the rate of GD in cohorts with ASD or ADHD. All English peer-reviewed publications were included. The search strategy identified 179 studies. After applying exclusion criteria, a total of 30 studies were identified, 22 studies which examined the prevalence of ASD or ADHD in people with GD. A further 8 studies examined the reverse; prevalence of GD in people with ASD. The few studies employing diagnostic criteria for ASD suggest a prevalence of 6-26% in transgender populations, higher than the general population, but no different from individuals attending psychiatry clinics. Few studies examine prevalence of ADHD. Low-level evidence exists to suggest a link between ASD and GD. Further population-based and controlled studies using diagnostic criteria for ASD and ADHD are required.

P108 Acetazolamide for obstructive hydrocephalus in the pregnant female: a case report and literature review.

ObjectivesThis study presents a case report and literature review of acetazolamide use in the pregnant patient to further delineate its role and controversies in the treatment of symptomatic hydrocephalus. Here we present a case from our neurosurgical service which demonstrated safe use and efficacy of acetazolamide in refractory hydrocephalus secondary to a space-occupying lesion.DesignCase report and literature review.Subjects33-year-old, primigravid female treated at Charing Cross Hospital, London.MethodsAdaptation of the PRISMA guideline to facilitate an initial PubMed database search for all available full-text, peer-reviewed publications in English. Papers were screened for relevance to pregnant patients with hydrocephalus receiving acetazolamide therapy, as well as relevant papers describing related disorders of cerebrospinal fluid flow.ResultsThere exist no prospective, randomised-controlled trials for the use of acetazolamide to treat hydrocephalus in pregnancy. Retrospective data in patients with related conditions suggest no significant link between acetazolamide use and teratogenicity in humans.ConclusionsAcetazolamide can be a safe and efficacious therapy in the pregnant patient with refractory hydrocephalus as a bridge to delivery. We agree with the consensus and its appropriate use in the pregnant neurosurgical patient.

Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review.

BackgroundUnhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear.ObjectiveThis study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes.MethodsWe systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies.ResultsIn total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory.ConclusionsMost studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.

Body image, physical activity, and sport: A scoping review

ObjectivesThis scoping review explored the associations between physical activity, sport, and body image. DesignScoping review. MethodThe studies were identified and selected using broad search criteria using MEDLINE, EMBASE, and PsycINFO via Ovid and CINAHL, Gender Studies and Sport Discus via EBSCO, from January 1, 2008 up to May 15, 2018 for English peer-reviewed publications. A rigorous evaluation following specific exclusion criteria ensued and 210 publications (182 quantitative, 26 qualitative, and 2 mixed-methods studies) were indexed and summarized using frequency counts. ResultsThe studies were focused exclusively on sport (14.8%) or physical activity (defined as structured or leisure; 85.2%). The majority of the quantitative studies (58.2%) focused on the relationship between physical activity or sport and body image whereas 41.8% explored how body image was either a protective factor or deterrent for physical activity or sport participation. Four qualitative studies specifically examined the intersection of physical activity or sport and body image experiences. Based on the frequency of reported findings in the journal articles, participation in physical activity and sport was related to less negative and more positive body image. Negative body image was linked to lower physical activity and sport participation and was discussed qualitatively as a barrier to participation. Positive body image was associated with greater participation in physical activity and sport. There was no empirical focus on the bi-directional and reciprocal associations between physical activity or sport and body image, thus precluding any causal conclusions. ConclusionsFuture research is needed using integrative conceptual frameworks and research designs that emphasize and delineate the causal, bi-directional, and reciprocal associations between body image and physical activity and sport behaviors.

Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals-A systematic review.

Cancers are a leading cause of death worldwide, and transgender individuals are no exception. The effects of gender-affirming hormone therapy (GAHT) on sex hormone-dependent tumours are unclear. Therefore, this review seeks to determine whether tumour risk in transgender individuals differs from the general population, to guide clinical screening recommendations. We performed a systematic review based on the PRISMA guidelines. MEDLINE, Embase and PsycINFO databases were searched for studies examining tumour incidence, prevalence or cancer-related mortality in transgender individuals. All English peer-reviewed publications were included if histological type and temporal relation to GAHT were reported. Case reports were included if there were ≥2 cases of the same histological type. The search strategy identified 307 studies. Excluding those that did not meet inclusion criteria, 43 studies (7 cohort studies, 2 cross-sectional studies and 34 case reports) were reviewed. Retrospective cohort studies suggest no increase in risk of tumour development in transgender individuals receiving GAHT compared to the general population. Notably, the mean ages of cohorts were young and were treated with GAHT for insufficient durations to assess tumour risk. Case reports raise potential associations between high-dose oestradiol and anti-androgen therapy with prolactinoma and meningioma, respectively. Further longitudinal studies are required to assess the risk of GAHT and hormone-dependent tumour development. Until further evidence is available, tumour screening should be based on guidelines for the general population and the presence of organs in transgender individuals rather than gender identity or hormonal therapy status.

What do hospitalists experience as barriers and helpful factors for having ACP conversations? A systematic qualitative evidence synthesis.

Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. A systematic synthesis of the qualitative literature was conducted. A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping. This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation.

Agricultural land use and infectious disease risks in southeast Asia: a systematic review and meta analyses

BackgroundAgricultural land use and land-use change activities are a major contributor to biodiversity loss, pollution, and carbon emissions. Evidence from multiple studies also implicates agricultural activities as a factor underlying a range of human infectious disease risks. However, these links have not been systematically assessed or quantified, hindering efforts to incorporate human health effects into land-use decision and policy making. In this study, we test and quantify the association between exposure to agricultural land use and human infectious disease risks, focusing on the highly diverse yet tractable example of southeast Asia. MethodsWe systematically reviewed English peer-reviewed publications from PubMed, EMBASE, Medline, Global Health, Google Scholar, and Web of Science databases between April 24, and Sept 10, 2017. Only studies done in southeast Asia testing the association between land use or changes in land use and infectious disease prevalence or incidence in human beings were included. We extracted crude and adjusted odds ratios (ORs) from the original studies, and for studies that did not present ORs, we calculated crude ORs provided sufficient data were available. We did a meta-analysis with mutually exclusive estimates using a random effects logistic regression model, with heterogeneity of effects addressed using prespecified subgroup analysis, the I2 test for heterogeneity and the Cochrane Q test. We assessed publication bias using funnel plots, a linear regression test, and the trim and fill method, and explored the effect of potential unmeasured confounders with an E-value analysis. The primary outcome was risk of infection in people who worked in agriculture or lived in an agricultural setting. FindingsOf 15 476 unique citations generated from our literature search, 37 articles were included in our meta-analysis. Our results showed that people who live or work in or near agricultural land are more likely to be infected with a pathogen than controls (OR 1·54, 95% CI 1·30–1·83, p<0·0001, E=2·16). Significant between-study heterogeneity was found, thereby warranting the use of subgroup analysis (land-use types and disease categories). No evidence of significant publication or measured or unmeasured confounder bias was detected. InterpretationThe results suggest that agricultural land use consistently exacerbates human infectious disease risks in southeast Asia, highlighting a clear need to consider human health effects of agricultural land use and land-use change policies alongside effects and benefits in other sectors. Although responses clearly vary by land-use and disease types, generalisable results from this and further studies could help identify co-management opportunities for health and the environment. FundingHS has received funding from the Grantham Institute and Commonwealth Scientific and Industrial Research Organisation (CSIRO). PH has received funding from the Natural Environment Research Council.

Paediatric gastrostomy stoma complications and treatments: A rapid scoping review.

To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use. Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice. A scoping review using a rapid review approach. Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data. Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections. The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted. Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support.

Sarilumab: Review of a Second IL-6 Receptor Antagonist Indicated for the Treatment of Rheumatoid Arthritis.

PubMed (1966 to January 2018), Clinicaltrials.gov (January 2018), and Scopus (1970 to January 2018) were searched using sarilumab, Kevzara, REGN88, and SAR153191. Human studies published in peer-reviewed publications in English were the primary sources for efficacy and safety. Data from randomized, double-blind, controlled, published clinical studies weeks demonstrated statistically significantly higher American College of Rheumatology (ACR) 20, ACR50, and Disease Activity Score-28 (DAS28) remission response rates and improvements in DAS28 and Health Assessment Questionnaire-Disability Index scores for sarilumab monotherapy versus adalimumab monotherapy (P < 0.05) and for sarilumab versus placebo in patients receiving methotrexate or other conventional synthetic disease-modifying antirheumatic drugs (DMARDs); P < 0.05. The ACR20 and ACR50 response rates were, respectively, 56-72% and 35-46% for sarilumab, 58% and 30% for adalimumab, and 33-34% and 15-18% for placebo. DAS28 remission rates were 20-34% for sarilumab, 7% for adalimumab, and 7-10% for placebo. Sarilumab has a higher risk for neutropenia than tocilizumab, the other IL-6 inhibitor, but a lower risk for dyslipidemia, injection site reactions, and gastrointestinal perforation. The acquisition costs of sarilumab are expected to be similar to those of most other biologic DMARDs. Sarilumab is an alternative to biologic DMARDs or targeted synthetic DMARDs in patients with moderate to severely active RA who have not responded adequately to prior conventional synthetic DMARDs or tumor necrosis factor-α inhibitors.